Treatment interval of neovascular age-related macular degeneration before and after macular hole repair

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IVOS Investigative Ophthalmology & Visual Science


Purpose : Prior reports have demonstrated that concurrent retinal diseases including endophthalmitis, vitreomacular traction, and rhegmatogenous retinal detachments may positively alter the natural history and treatment course of neovascular age related macular degeneration (NVAMD). We evaluated if the surgical repair of a full thickness macular hole (FTMH) modulated disease activity and treatment response in those with coexisting NVAMD.

Methods : An interventional, retrospective, consecutive case series was conducted on patients treated at Associated Retinal Consultants P.C. (Royal Oak, Michigan, USA) between 2013 and 2019. Those treated with an anti-VEGF agent for NVAMD who developed a concurrent FTMH and underwent surgical repair were included. Preoperative demographic data, visual acuity (VA), funduscopic examination, optical coherence tomography, anti-VEGF agent, and injection frequency (# injections/year) were reviewed and compared postoperatively. The main outcomes measured were VA and injection frequency.

Results : Eight eyes in 8 patients were identified. The average length of follow-up after macular hole repair was 14 months (5 to 33 months). The primary closure rate was 87.5% (7 of 8). Seven patients were being treated with ranibizumab and one with aflibercept at time of surgery. Average VA prior to surgery was 20/226 (logMAR of 0.47 to 1.6) which did not significantly change following surgery 20/275 (logMAR of 0.3 to 1.6) (p = 0.33). There was no difference (p = 0.21) in injection frequency before (8.6/year; 3.5 to 13/year) and after surgery (7.1/year, 0 to 13/year). Two patients stopped receiving injections entirely after surgery due to progression to a disciform scar not responsive to further therapy.

Conclusions : Based on this preliminary evaluation, it seems that surgical repair of a FTMH does not alter the activity of the choroidal neovascular membrane in NVAMD based on injection frequency. Additionally, the success rate of primary hole closure and VA in those with NVAMD is consistent with prior reports.





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